Background The goal of our study was to find out whether the immunohistochemical expression of nuclear factor-kappa beta (NF-κB) p65 in biopsy samples with Gleason score 3 + 3 = 6 (GS 6) can be a ...negative predictive factor for Prostate cancer (PCa) indolence. Patients and methods Study was conducted on a retrospective cohort of 123 PCa patients with initial total PSA ≤ 10 ng/ml, number of needle biopsy specimens ≥ 8, GS 6 on biopsy and T1/T2 estimated clinical stage who underwent laparoscopic radical prostatectomy and whose archived formalin-fixed and paraffin-embedded (FFPE) prostate needle biopsy specimens were used for additional immunohistochemistry staining for detection of NF-κB p65. Both cytoplasmic and nuclear NF-κB p65 expression in biopsy cores with PCa were correlated with postoperative pathological stage, positive surgical margins, GS and biochemical progression of disease. Results After follow-up of 66 months, biochemical progression (PSA ≥ 0.2 ng/ml) occurred in 6 (5.1%) patients, 3 (50%) with GS 6 and 3 (50%) with GS 7 after radical prostatectomy. Both cytoplasmic and nuclear NF-κB p65 expressions were not significantly associated with pathological stage, positive surgical margin and postoperative GS. Patients with positive cytoplasmic NF-kB reaction had significantly more frequent biochemical progression than those with negative cytoplasmic NF-kB reaction with PSA 0.2 ng/ml as cutoff point (p = 0.015) and a trend towards more biochemical progression with PSA ≥ 0.05 ng/ml as cutoff point (p = 0.068). Conclusions Cytoplasmic expression of NF-κB is associated with more biochemical progression and might be an independent prognostic factor for recurrence-free survival (RFS), but further studies including larger patient cohorts are needed to confirm these initial results.
Short- and long-term effectiveness of laparoscopic nephropexy was evaluated in patients with symptomatic nephroptosis especially quality of life of the patients and repositioning of the ptotic ...kidney. In 87 patients with symptomatic nephroptosis laparoscopic nephropexy was performed from 1994 to 2003. In 86 patients trans-abdominal approach was used and retroperitoneal in one patient. Visual pain scale was used for pain evaluation before surgery and six month after surgery. At the same period creatinine serum concentration, urine examination, i.v. urography and ultrasound in supine and erect position was made. There was statistical significant decrease of pain from 6.5 +/- 1.055 (SD) to 2.4 +/- 1.577 (SD) (p = 0.000), according to visual scale, and decrease of urinary tract infections (p = 0.000) in patients after laparoscopic nephropexy. Average operative time was 45.9 +/- 8 (SD) min., and hospital stay 3.4 +/- 0.7 (SD) days. Reposition of the kidney was successful in 70 of 80 patients. Laparoscopic nephropexy importantly improved the quality of life in patients with symptomatic nephroptosis. Surgical procedure was safe and successful in most of the patients.
Laparoscopic radical prostatectomy is nowadays one of the most frequently performed urological surgical procedures. For insufflation in laparoscopic radical prostatectomy (LRP) CO2 is used, with the ...pressure in the operative region between 12 and 15 mm Hg. At the microcirculation level, the pressure is lower, which raises the possibility of ischemic tissue damage during the procedure. The activity of glutathione peroxidase (GSH-px), superoxide dismutase (SOD) and catalase (CAT) was measured at the beginning and immediately after the end of the surgery in 44 patients who underwent LRP and in 11 who underwent retropubic radical prostatectomy (RRP). Capillary endothelial damage was assessed by applying immunohistochemical and morphometric methods to tissue samples from the urinary bladder neck, which contains all layers of the bladder wall. Measurement of the enzyme activity showed no significant increase of GSH-px (p-0.431), SOD (p-0.220) and CAT (p-0.434) levels. Neither immunohistochemical analysis of the bladder neck capillaries with i-nitric oxide synthase (i-NOS) nor morphometric analysis showed signs of endothelial ischemic damage.
Namen: Namen raziskave je bil preveriti vpliv prisotnosti vnetja in/ali atrofije v vzorcih igelne biopsije prostate na oceno indolentnosti karcinoma prostate in tveganja za napredovanje karcinoma pri ...bolnikih z GS 3+3=6 ter morebitno povezanost obeh z aktivacijo NF-κB v citoplazmi in jedru karcinomskih celic. Raziskavo smo razširili še na analizo povezanosti pozitivne IHK reakcije na NF-κB p65 v citoplazmi in v jedru karcinomskih celic z biokemično ponovitvijo karcinoma pri obravnavanih bolnikih.Bolniki in metode: Raziskava je temeljila na retrospektivni analizi kliničnih podatkov bolnikov, ki so bili diagnosticirani, operirani in vsaj 5 let po operaciji spremljani na Oddelku za urologijo v Splošni bolnišnici Slovenj Gradec. Vključitveni kriteriji za uvrstitev bolnikov v raziskavo so bili izhodiščni PSA ≤ 10,0 ng/ml, GS 3+3=6, število vzorcev igelne biopsije prostate ≥ 8, klinični stadij T1-2 ter dostopni podatki o kontrolnih vrednostih PSA 1, 6, 18, 30, 42, 54 in 66 mesecev po radikalni prostatektomiji. Vključenih je bilo 177 bolnikov. Pri 16 je bil ugotovljen GS 3+4=7, zato so bili izključeni iz nadaljnje raziskave. Glavni del študije je bil izveden na 161, od teh je bilo v del, ki se je nanašal na NF-κB, vključenih 123 bolnikov. V sklopu raziskave so bile na tkivnih vzorcih igelne biopsije prostate vključenih bolnikov, arhiviranih na Oddelku za patologijo iste bolnišnice, opravljene še dodatna patohistološka analiza prisotnosti vnetja in/ali atrofije, ocena odstotka zajetja vzorca s tumorjem pri bolnikih z ≤ 2 pozitivnima stebričkoma na igelni biopsiji ter imunohistokemična detekcija NF-κB v pozitivnih vzorcih biopsije. Izsledke teh analiz smo primerjali s klinično patološkimi dejavniki tveganja za ponovitev bolezni po radikalni prostatektomiji.Rezultati: Biokemično ponovitev karcinoma prostate z mejno vrednostjo PSA 0,05 ng/ml smo ugotovili pri 16,9 % bolnikov, z mejno vrednostjo 0,2 ng/ml pa pri 5,8 %. Manj kot 50 % s karcinomom zajetega tkiva v enem ali v obeh pozitivnih vzorcih igelne biopsije prostate je bilo pri 101 bolniku.Med 161 bolniki je bilo na preparatih igelne biopsije samo vnetje ugotovljeno pri 45 (27,9 %), samo atrofija pri 46 (28,6 %), vnetje in atrofija skupaj pa pri 23 (14,3 %). V analizo IHK reakcije na NF-κB p65 so bili vključeni 123 bolniki. Citoplazemska IHK reakcija je bila pozitivna pri 63 (51,2 %), jedrna pa pri 20 (16,3 %) bolnikih. V delu študije, ki se je nanašal na povezanost pozitivne IHK reakcije na NF-κB p65 z biokemično ponovitvijo bolezni je bilo vključenih 118 bolnikov. Po 66 mesecih spremljanja je do biokemične ponovitve bolezni (PSA ≥ 0,2 ng/ml) prišlo pri 6 (5,1%) bolnikih, od tega je pri 3 (50 %) šlo za GS 3+3=7, pri 3 (50%) pa za GS 3+4=7. V analizi povezanosti prisotnosti vnetja in/ali atrofije v vzorcih igelne biopsije prostate s klinično patološkimi dejavniki tveganja za napredovanje KP statistično značilne povezanosti nismo ugotovili. Prav tako prisotnost vnetja ni bila statistično povezana z biokemično ponovitvijo bolezni. Povezanosti IHK reakcije na NF-κB p65 s klinično patološkimi dejavniki tveganja za biokemično ponovitev bolezni po radikalni prostatektomiji v citoplazmi in v jedru smo statistično potrdili samo pri pozitivni IHK reakciji v citoplazmi v povezavi z NCCN tveganjem (P = 0,044).
The aim of this study was retrospective study of our first 100 consecutive cases of prostatic cancer, operated by laparoscopic approach and comparison with 100 cases of open retropubic radical ...prostatectomy (RRP) at our department, focusing on operative data and morbidity. From June 1999 to August 2003 we have performed first consecutive 100 laparoscopic radical prostatectomies (LRP), all according to Montsouris technique. In this study we have compared the results with 100 patients who underwent from May 1997 to August 2003 open RRP. Mean operative time was shorter after RRP (155 vs. 234 min, p = 0.018). Mean blood loss was significantly lower in LRP group (446 vs. 710 ml, p < 0.001). Mean catheter duration time (6.4 vs. 10 days, p < 0.001) and hospital stay (8.6 vs. 11 days, p < 0.001) were significantly shorter in LRP group. There was no statistically significant difference in complication rate in both groups (p = 0.139). Laparoscopic radical prostatectomy is a safe procedure for the patient and complications do not appear more often than in the open operation. In LRP we detected shorter mean catheter duration time, shorter hospital stay and less blood loss. This procedure demands perfect knowledge of the laparoscopic operative technique and due to long-term learning curve, the procedure could be done only in particular centers, where exist suitable equipment and also experienced operators in laparoscopic technique.
Adherence to national and international clinical practice guidelines is suboptimal throughout Europe. The European Association of Urology Guidelines Office project “IMAGINE” (IMpact Assessment of ...Guidelines Implementation and Education) has been developed to measure baseline adherence to urological guideline recommendations across Europe and to identify issues that drive nonadherence.
Laparoscopic radical prostatectomy is nowadays one of the most frequently performed urological surgical procedures. For insufflation in laparoscopic radical prostatectomy (LRP) CO2 is used, with the ...pressure in the operative region between 12 and 15 mm Hg. At the microcirculation level, the pressure is lower, which raises the possibility of ischemic tissue damage during the procedure. The activity of glutathione peroxidase (GSH-px), superoxide dismutase (SOD) and catalase (CAT) was measured at the beginning and immediately after the end of the surgery in 44 patients who underwent LRP and in 11 who underwent retropubic radical prostatectomy (RRP). Capillary endothelial damage was assessed by applying immunohistochemical and morphometric methods to tissue samples from the urinary bladder neck, which contains all layers of the bladder wall. Measurement of the enzyme activity showed no significant increase of GSH-px (p-0.431), SOD (p-0.220) and CAT (p-0.434) levels. Neither immunohistochemical analysis of the bladder neck capillaries with i-nitric oxide synthase (i-NOS) nor morphometric analysis showed signs of endothelial ischemic damage.
The aim of this study was retrospective study of our first 100 consecutive cases of prostatic cancer, operated by laparoscopic approach and comparison with 100 cases of open retropubic radical ...prostatectomy (RRP) at our department, focusing on operative data and morbidity. From June 1999 to August 2003 we have performed first consecutive 100 laparoscopic radical prostatectomies (LRP), all according to Montsouris technique. In this study we have compared the results with 100 patients who underwent from May 1997 to August 2003 open RRP. Mean operative time was shorter after RRP (155 vs. 234 min, p = 0.018). Mean blood loss was significantly lower in LRP group (446 vs. 710 ml, p < 0.001). Mean catheter duration time (6.4 vs. 10 days, p < 0.001) and hospital stay (8.6 vs. 11 days, p < 0.001) were significantly shorter in LRP group. There was no statistically significant difference in complication rate in both groups (p = 0.139). Laparoscopic radical prostatectomy is a safe procedure for the patient and complications do not appear more often than in the open operation. In LRP we detected shorter mean catheter duration time, shorter hospital stay and less blood loss. This procedure demands perfect knowledge of the laparoscopic operative technique and due to long-term learning curve, the procedure could be done only in particular centers, where exist suitable equipment and also experienced operators in laparoscopic technique.
Short- and long-term effectiveness of laparoscopic nephropexy was evaluated in patients with symptomatic nephroptosis
especially quality of life of the patients and repositioning of the ptotic ...kidney.In 87 patients with symptomatic
nephroptosis laparoscopic nephropexy was performed from 1994 to 2003. In 86 patients trans-abdominal approach was
used and retroperitoneal in one patient. Visual pain scale was used for pain evaluation before surgery and six month after
surgery. At the same period creatinine serum concentration, urine examination, i.v. urography and ultrasound in supine
and erect position was made. There was statistical significant decrease of pain from 6.5±1.055 (SD) to 2.4±1.577
(SD) (p=0.000), according to visual scale, and decrease of urinary tract infections (p=0.000) in patients after laparoscopic
nephropexy. Average operative time was 45.9±8 (SD) min., and hospital stay 3.4±0.7 (SD) days. Reposition of the
kidney was successful in 70 of 80 patients. Laparoscopic nephropexy importantly improved the quality of life in patients
with symptomatic nephroptosis. Surgical procedure was safe and successful in most of the patients.
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